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· Mal- alignment causes abnormal stresses on foot, ankle, lower leg, knees and hips
· Anteriorly- straight line drawn from anterior superior iliac spine through patella and between 1st and 2nd toes
· Laterally, straight line from greater trochanter through center of patella and just behind lateral malleous
· Posterioly, line through lower leg, midline to Achilles and calcaneus
· Internal or external tibial torsion also common mal-alignment
Lower leg alignment
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· blow to the tibia, fibula, to create vibratory force that resonates w/ fx
· tuning fork can be used
Percussion test
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· compression of tibia and fibula either above or below site of concern
compression
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· Squeeze calf muscle, while foot extended off table to check integrity
· Positive- no movement in foot
Thompson test
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· test for deep vein thrombophleitis (blood clot)
· knee extended and foot off table, ankle in dorsiflexion
· positive- referred pain in calf
Homan's test
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· determine damage to ant talofib ligament or other lateral ligament
· pull up on ankle, down on talo fib
· Positive- - foot slides forward and/or makes clunking sound as reaches end point
Anterior Drawer test
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· determine extent of inversion or eversion injuries
· twist test
· positive- foot at 90 deg, calcaneus inverted and excessive motion means injury to calcaneoflbular ligament and possible ant and post talofib ligaments
· if calcaneus everted, deltoid tested
Talar tilt test
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· determines extent off damage to deltoid ligaments
·may be used to evaluate distal ankle syndesmosis, ant/post tibfib ligaments, and interosseus membrane
· w/ lower leg stabilized, foot rotated laterally to stress deltoid
Kleiger's test
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· determines pressence of excessive medial translation of calcaneus on talus
· talus stabilized in subtalar neutral while other hand glides calcaneus medially
· positive- excessive movement indicates injury to lateral ligaments
Medial Subtalar Glide test
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